Creating a culture of prevention and recovery

Developing a Culture of
Prevention, Recovery &
Wellness for Our Futures NOW!
Dennis D. Embry, Ph.D., President/Senior
Scientist,PAXIS Institute
Keynote Presentation:
Texas Behavioral Health Institute, Austin, TX, July 17, 2012
1Wednesday, July 18, 12

What good things do the people of
Texas want to pack in the suitcase
for life of their children?
What heavy things do the people of
Texas NOT want to pack in the
suitcase for life of their children?

How many of you know…
2x

35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)

35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety

35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior

35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Mood

35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Substance
Behavior
Mood

Nearly 3 out of 4 of United States 17- to 24-year-olds are
ineligible for military service for based on national
epidemiological data (not service entrance exams)
Medical/physical problems, 35
percent.
Illegal drug use, 18 percent.
Mental Category V (the lowest 10
percent of the population), 9
percent.
Too many dependents under age
18, 6 percent.
Criminal record, 5 percent.
Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd

By 21 years of age,
61.1% of participants
had met criteria for a
well-speciﬁed psychiatric
disorder.
An additional 21.4% had
met criteria for a not
otherwise speciﬁed
disorder only, increasing
the total cumulative
prevalence for any
disorder to 82.5%.
Cumulative prevalence of psychiatric disorders by young adulthood
a prospective cohort analysis from the Great Smoky Mountains Study.

The US has
75 million
children and
teens.
40.4 million
are on
psychotropic
medications
Wall Street Journal, 12-28-2010

Depression Onset By Birth Cohort

Born 1986-1995?

Born 1986-1995?
Born 1996-2005?

Evolutionary bottleneck
1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈ ≈
Disease & War26,000 to 12,000 B.E. Extermination,
Marginalization,
& Suppression
The America’s First Peoples…
Residential
Schools;
Western Diet

1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈ ≈
Today,
Historic
Disparities
Disease & War26,000 to 12,000 B.E. Extermination,
Marginalization,
& Suppression
The America’s First Peoples…
Residential
Schools;
Western Diet

Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Middle
Passage
Continuing
Trauma
Institution
of Slavery
Separation,
violence,
malnutrition
Jim
CrowAfrican Americans…
Exposure
to Toxins
&
Racism
The Great
Migration
North

Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Today,
historic
disparities
Middle
Passage
Continuing
Trauma
Institution
of Slavery
Separation,
violence,
malnutrition
Jim
CrowAfrican Americans…
Exposure
to Toxins
&
Racism
The Great
Migration
North

Epigenesis
Epigenetics are
heritable
changes in
gene expression
caused by
mechanisms
other than
changes in the
underlying DNA
sequence.
These changes
can pass
through multiple
generations.
Genesis
Social Biological
Environmental Inputs
Nurturing or Toxic
Environments,
Disease, or
Threats
Signaling
M
orphogensis
Phosphorlyation
Acetylation
Methylation
Histone Remodeling
Chromatin Stucture Changes
Development Immunity Stem Cell Changes Imprinting
Three
Generation
Effects
Parent,
1st Generation
Baby,
2nd Generation
Reproductive Cells,
3rd Generation
These
polygenes
can be
“added”,
“subtracted”,
“divided”, or
“multiplied.”

Youthanasia

Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &
Elders

Our
Children
Our
Adults &
Elders
adults and elders invest in children

Our
Children
Our
Adults &
Elders
Youth return the favor as adults
adults and elders invest in children

We are the ﬁrst civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds

5-Year
Olds
65-Year
Olds
Who are living
longer though get
progressively sicker…

5-Year
Olds
65-Year
Olds
Who are living
longer though get
Requiring more wealth transfer

5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get

5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get
But elders voting to stop funds to kids

5-Year
Olds
65-Year
Olds

65-Year
Olds

Our Own Future and Our Own Children’s Future

Our Own & Our Children’s Future Rests On Other’s Futures

Our Own & Our Children’s Future Rests On Other’s Futures
depression
bipolar
drugs
tobacco
alcohol
ADHD
aggression
learning disabilities
stealing
suicide
depression
crime
violence
dangerous acts
asthma
obesity cancer
heart-disease
diabetes
hi-blood pressure

Key facts that predict our futures in America…
and, by the way, Texas…

Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.

Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.
Our current adults
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders among
the rich
democracies.

Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.
Our bulge of
retiring
boomers have
high rates of
these same
problems plus
medical
problems of
aging.
Our current adults
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders among
the rich
democracies.

What these trends this predict for small
businesses in America & Texas?

What do these trends predict for US
global economic competitiveness?

global economic competitiveness?
safety and security?

Who in Texas can act to protect our futures?
And how much could we reduce these problems?

Psychological ﬂexibility is required…

Mental, Emotional and Behavior Disorders = MEBs

Available at:
www.slideshare.net/drdennisembry
The Critical Role of Nurturing Environments for
Promoting Human Well-Being
Anthony Biglan Oregon Research Institute
Brian R. Flay Oregon State University
Dennis D. Embry PAXIS Institute
Irwin N. Sandler Arizona State University
The recent Institute of Medicine report on prevention (Na-
tional Research Council & Institute of Medicine, 2009)
noted the substantial interrelationship among mental, emo-
tional, and behavioral disorders and pointed out that, to a
great extent, these problems stem from a set of common
conditions. However, despite the evidence, current re-
search and practice continue to deal with the prevention of
mental, emotional, and behavioral disorders as if they are
unrelated and each stems from different conditions. This
article proposes a framework that could accelerate prog-
ress in preventing these problems. Environments that foster
successful development and prevent the development of
psychological and behavioral problems are usefully char-
acterized as nurturing environments. First, these environ-
ments minimize biologically and psychologically toxic
events. Second, they teach, promote, and richly reinforce
prosocial behavior, including self-regulatory behaviors
and all of the skills needed to become productive adult
members of society. Third, they monitor and limit oppor-
tunities for problem behavior. Fourth, they foster psycho-
logical flexibility—the ability to be mindful of one’s
thoughts and feelings and to act in the service of one’s
values even when one’s thoughts and feelings discourage
taking valued action. We review evidence to support this
synthesis and describe the kind of public health movement
that could increase the prevalence of nurturing environ-
ments and thereby contribute to the prevention of most
mental, emotional, and behavioral disorders. This article is
one of three in a special section (see also Munõz Beardslee,
& Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012)
representing an elaboration on a theme for prevention
science developed by the 2009 report of the National Re-
The next big challenge is to translate this knowledge into
significant reductions in the incidence and prevalence of
multiple disorders.
Doing so requires us to accept two other conclusions
of the report: Psychological and behavioral disorders and
related problems co-occur (e.g., Biglan, Brennan, Foster, &
Holder, 2004; Donovan, Jessor, & Costa, 1993; Flay,
2002), and these problems stem largely from the same
conditions (Biglan et al., 2004; Flay, Snyder, & Petraitis,
Editor’s note. This article is one of three in a special section presented
in this issue of the American Psychologist (May–June 2012) representing
an elaboration on an important theme for prevention science developed by
the landmark report of the National Research Council and Institute of
Medicine (NRC & IOM, 2009). That report summarized the impressive
progress in prevention research that has occurred over the past two
decades with children and youth. The report also presented recommenda-
tions for the next generation of research and policy initiatives to translate
this progress into true improvements in the mental health of America’s
children and youth. One theme in the report concerns the power of
positive aspects of the social environment to promote positive develop-
ment and to prevent the development of disorder. The current article
develops a coherent, empirically based, theoretical framework for con-
ceptualizing the positive aspects of the social environment, which the
authors have labeled “nurturing environments.” The other articles in this
special section elaborate on two other themes in the NRC & IOM report,
one of which concerns the salient role of poverty as a pervasive risk factor
(Yoshikawa, Aber, & Beardslee, 2012) and the other of which concerns
the potential for preventing the incidence of depression, a major mental
disorder (Munõz, Beardslee, & Leykin, 2012).
Authors’ note. Anthony Biglan, Promise Neighborhoods Research
Consortium, Oregon Research Institute, Eugene, Oregon; Brian R. Flay,
College of Public Health and Human Sciences, Oregon State University;
Dennis D. Embry, PAXIS Institute, Tucson, Arizona; Irwin N. Sandler,

Behavioral Vaccines and
Evidence-Based Kernels:
Nonpharmaceutical
Approaches for the
Prevention of Mental,
Emotional, and
Behavioral Disorders
Dennis D. Embry, PhD
KEYWORDS
Evidence-based kernels Behavioral vaccines Prevention
Public health
Available at:

Available at:
Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Dennis D. Embry Æ Anthony Biglan
Ó The Author(s) 2008. This article is published with open access at Springerlink.com
Abstract This paper describes evidence-based kernels,
fundamental units of behavioral influence that appear to
underlie effective prevention and treatment for children,
adults, and families. A kernel is a behavior–influence
procedure shown through experimental analysis to affect a
specific behavior and that is indivisible in the sense that
removing any of its components would render it inert.
Existing evidence shows that a variety of kernels can
influence behavior in context, and some evidence suggests
that frequent use or sufficient use of some kernels may
produce longer lasting behavioral shifts. The analysis of
kernels could contribute to an empirically based theory of
behavioral influence, augment existing prevention or
treatment efforts, facilitate the dissemination of effective
prevention and treatment practices, clarify the active
ingredients in existing interventions, and contribute to
efficiently developing interventions that are more effective.
Kernels involve one or more of the following mechanisms
of behavior influence: reinforcement, altering antecedents,
changing verbal relational responding, or changing physi-
ological states directly. The paper describes 52 of these
kernels, and details practical, theoretical, and research
implications, including calling for a national database of
kernels that influence human behavior.
This paper presents an analysis of fundamental units of
behavioral influence that underlie effective prevention and
treatment. We call these units kernels. They have two
defining features. First, in experimental analysis,
researchers have found them to have a reliable effect on
one or more specific behaviors. Second, they are funda-
mental units of behavior influence in the sense that deleting
any component of a kernel would render it inert. Under-
standing kernels could contribute to an empirically based
theory of behavioral influence, facilitate dissemination of
effective prevention and treatment practices, clarify the
active ingredients in existing interventions, and contribute
to developing interventions that are more efficient and
effective. Subsequent sections of this paper expand on the
two essential features of evidence-based kernels, as well as
the origins of the idea and terminology.
The ultimate goals of treatment and prevention research
are a reduction of the prevalence of the most common and
costly problems of behavior and an increase in the preva-
lence of wellbeing. Current thinking about how to
accomplish this assumes that we will identify empirically
supported programs and, to a lesser extent, policies, and
will disseminate them widely and effectively. Although
substantial progress is occurring through this strategy, there
Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x

Physiological
inﬂuences trigger
adverse biological
mechanisms
Reinforcement
more for anti-social
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses
Multi-Inﬂammatory Brain Body Response

Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
Healing
Dysfunction
Physiological
inﬂuences trigger
adverse biological
mechanisms
Reinforcement
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Multi-Inﬂammatory Brain Body Response

Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
Healing
Dysfunction
Physiological
inﬂuences trigger
adverse biological
mechanisms
Reinforcement
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Mental Illness
Substance
Abuse
Violence
Work
Problems
Obesity,
etc
CancerEarly
Sex
School
Failure
STD’s Special
EdMulti-Inﬂammatory Brain Body Response

Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
Addictions
New cultural trends predict new challenges and risks

Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
AddictionsOmega 3
Fatty Acid
Deﬁciency
Vitamin D
Deﬁciency
Reduced
Outdoor
Activities
Fear of
Violence
Crime
Increased
Electronic
Media Use

Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
AddictionsOmega 3
Fatty Acid
Deﬁciency
Vitamin D
Deﬁciency
Reduced
Outdoor
Activities
Fear of
Violence
Crime
Increased
Electronic
Media Use
Lower Rates
of Positive
Reinforcement

Four Types of Kernels
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry of
behavior
Embry, D. D., Biglan, A.
(2008). Evidence-Based
Kernels: Fundamental Units of
Behavioral Inﬂuence. Clinical
Child Family Psychology
Review, 39.

Physiological
influences trigger
protective biological
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation
Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults
Multi Anti-Inflammatory Brain Body Response

Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healing
Efficiency
Physiological
influences trigger
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation

Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healing
Efficiency
Physiological
influences trigger
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation
Mental health
Low
Addictions
Prosociality
Work
Success
Heart
Health
etc
Low
Cancer
Delayed
Sex
Hi Sch.
Grad
Low
Injuries
Higher
Ed

Kernels are building
blocks of behavior change
Humans survive individually and collectively by
inﬂuencing the behavior or other humans
The 2008 paper by Embry and Biglan identiﬁes
52 evidence based kernels that can be used to
design or or improve programs.

Table2:Examplesofkernelsforselected,indicatedanduniversalprevention
Kernel Treatment Intervention Prevention/Protection
Prize
Bowl/Mystery
Motivator
(reinforcement)
Reduce/alcohol,/tobacco,/or/
drug/use/to/Improve/
engagement/in/treatment/
goals./
Reduce/problem/behavior/
in/high;risk/children/or/
youth./
Improve/engaged/learning/
and/reduce/disruptions/of/
whole/class./
Goal/Node
Mapping
(relational/frame)
Reduce/relapse/or/
recidivism/rates/or/to/
improve/recovery/
Prevent/ATOD/use/rates/of/
improve/attainment/of/
therapeutic/goals//
Increase/academic/success/
or/cognitive/processes//
OmegaG3fatty
acid
supplementation
(physiological)
Treat/depression,/
borderline,/and/or/bipolar/
disorder./Reduce/autism/
symptoms./
Prevent/emergence/of/
psychotic/episodes/in/
prodromal/adolescents./
Improve/children’s/
cognitive/performance/and/
prevent/behavioral/
disorders./
Publicposting
(antecedent)/
Reduce/community/illegal/
behaviors./
Improve/problematic/
behavior/in/therapeutic/
settings//
Reduce/impulsive/or/risky/
behaviors/in/general/
population//
Promoting/participation/or/
community/goods//
Kernels can be used across the lifespan…

Protecting our children right now

Muriel Saunders
PAX GBG: An Example Behavioral Vaccine
Read about multiple scientiﬁc studies on the “Good Behavior Game” at www.pubmed.gov

Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry genes
of behavior

Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry genes
of behavior
Multiple
non-verbal
transition
cues

Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry genes
of behavior
Multiple
non-verbal
transition
cues
Mystery
Motivator
Premack
Principle;
Group Rewards

Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry genes
of behavior
Multiple
non-verbal
transition
cues
Mystery
Motivator
Premack
Principle;
Group Rewards
Motivational
Interview
Group
Identity

Timeline of Life Time Beneﬁts…

Timeline of Life Time Beneﬁts…
More time for
teaching and learning
First Month
Less stress for
Staff Students
Better
Attendance
Better
Academics
Less
Illness
Fewer Service
Needs
Fewer
Referrals
First Year
Happier
Families
Less
Vandalism
2nd 3rd Years
ADHD
Averted
Oppositional
Deﬁance Averted
Special Education
Averted
5-15 Years
No
Tobacco
Less
Alcohol
Less Conduct
Disorders
Delayed
vaginal sex
Less Crime,
Violence, Suicide
High School
Grad University

How much might PAX GBG
save for Texans?
To do PAX GBG will cost about $150 to protect our children for
life from mental illnesses, behavioral problems, drug addictions,
becoming a criminal, trying suicide, dying from tobacco or
alcohol related illnesses. And, it increases their academic
success—including university entry.
PAX GBG pays back $4,636 to individuals, taxpayers, and
others per student exposed in First Grade over 15 years.
Assuming 40,000 First Graders each year, that saves
$186 million every First Grade cohort.
Cost
Savings
Source: Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., et al. (2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. (July), 8. Retrieved from http://www.wsipp.wa.gov/rptﬁles/11-07-1201.pdf

First graders
exposed to GBG
for one year had
these beneﬁts at
age 21.
SOURCE: Kellam, S. G., Mackenzie, A. C., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., Wilcox, H. C. (2011). The good behavior game and the future of prevention and treatment. Addict Sci Clin Pract, 6(1), 73-84.
Read this and other studies about the Good Behavior Game at www.pubmed.gov
OUTCOMES STUDENT GROUPS GBG CLASSROOM STANDARD CLASSROOM
Drug abuse and All males 19 percent 38 percent
dependence disorders
Highly aggressive males 29 percent 83 percent
Regular smoking All males 6 percent 19 percent
Highly aggressive males 0 percent 40 percent
Alcohol abuse and All males and females 13 percent 20 percent
dependence disorders
Antisocial personality Highly aggressive males 40 percent 100 percent
disorder (ASPD)
Violent and criminal Highly agressive males 34 percent 50 percent
behavior (and ASPD)
Service use for All males 25 percent 42 percent
problems with behavior,
emotions, drugs, or
alcohol
Suicidal thoughts All females 9 percent 19 percent
All males 11 percent 24 percent

Lifespan example of one kernel
for prevention, intervention and
treatment
Reinforcement
Kernel
Happens AFTER
the behavior
Available from Amazon.com for $45

Giggle Fest Giving Cuts in
Line
Mumble, Grumble
Gowl
Play Hangman
Jokester Making Faces
Nerf Toss or
Nerf Basket
Paper Airplane
Toss
Pencil Tapping Penny or Poker
Chip Flipping
possible in the time set. You can’t help but giggle.
Suggested Time: 10 to 20 seconds
Winning teams can give cuts to a friend for one set
time as determined by the teacher
Suggested Time: One lunch, or day only.
Suggested Time: 10 to 20 seconds
Winning teams get to mumble, grumble and growl as
much as possible during the set time.
Winning teams are allowed to play a game of hang-
man for a time set by the teacher.
Suggested Time: 1-2 minutes; more at day’s end
Suggested Time: 1-3 minutes, depending on joke book
A joke is read for each winning team. Teacher may
read them or team captains can read the jokes. (Teach-
er needs to have several joke books ready.)
Winning teams may make faces at each other or the
teacher.
Suggested Time: 10-30 seconds.
Suggested Time: About 1-2 mins, based on nerf balls
Winning teams get to line up and toss a nerf ball into a
box, bin or mini basketball hoop.
-
ing them. (Nice at the end of the day prize)
Suggested Time: A few minutes to make, then toss
Suggested Time: 10 seconds or so.
cups or jars. You can make some containers smalller
for more “points”.
Suggested Time: A minute or so
PAX TIP: Please cut out and select prizes appropriate for you. Start and stop the prizes with PAX Quiet.
Using prize bowl or mystery
motivator in prevention

Seine River Pilot Demonstration
April, 2011 – Principals and key
staff trained for two days for all
12 schools.
April, 2011 – First grade
classrooms then trained that
week
April through May – Each
successive month other grades
trained, including 8th grade
0
2
4
6
8
10
12
Before
(Baseline)
After
PAX GBG
Disruptions by All Seine River First Graders
RatePerHourPerChild
40.8%
Reduction
45%

An ancient inukshuk points the
way
0%
6%
12%
18%
24%
30%
Psychosis
Omega-3 Placeo
27.5%
4.9%
PercentagewithPsychosisat12months
Physiological
Kernel
Changes
biochemistry of
behavior
Brief Report
Omega-3 Fatty Acid Treatment of Women
With Borderline Personality Disorder:
A Double-Blind, Placebo-Controlled Pilot Study
Mary C. Zanarini, Ed.D.
Frances R. Frankenburg, M.D.
Objective: The purpose of this study was to compare the effi-
cacy of ethyl-eicosapentaenoic acid (E-EPA) and placebo in the
treatment of female subjects with borderline personality disorder.
Method: The authors conducted an 8-week, placebo-con-
trolled, double-blind study of E-EPA in 30 female subjects meet-
ing Revised Diagnostic Interview for Borderlines and DSM-IV cri-
teria for borderline personality disorder.
Results: Twenty subjects were randomly assigned to 1 g of E-
EPA; 10 subjects were given placebo. Ninety percent of those in
both groups completed all 8 weeks of the trial. Analyses that
used random-effects regression modeling and controlled for
baseline severity showed E-EPA to be superior to placebo in
diminishing aggression as well as the severity of depressive
symptoms.
Conclusions: The results of this study suggest that E-EPA may
be a safe and effective form of monotherapy for women with
moderately severe borderline personality disorder.
(Am J Psychiatry 2003; 160:167–169)
Borderline personality disorder is marked by notable
reactivity of mood and impulsive aggression. Because re-
sponse to antidepressants and mood stabilizers has typi-
cally been clinically modest in this patient group (1), the
identification of novel treatments is needed. Candidates
include omega-3 fatty acids, such as eicosapentaenoic
acid and docosahexaenoic acid, which are commonly
found in seafood and have beneficial effects and none of
the adverse side effects commonly associated with phar-
macotherapy. In cross-national studies, greater seafood
consumption was associated with lower rates of bipolar
disorder (30-fold range) and major depression (50-fold
range) (2). In placebo-controlled trials, a mixture of these
fatty acids was found to be an effective adjunctive agent
for patients suffering from bipolar disorder (3), and ethyl-
eicosapentaenoic acid (E-EPA) was found to have a bene-
ficial adjunctive effect for patients suffering from recur-
rent depression (4). Because of the shared symptoms of
borderline personality disorder and these mood disorders,
a double-blind, placebo-controlled trial of E-EPA seemed
warranted.
Method
Recruitment of women between the ages of 18 and 40 was ac-
complished through advertisements in Boston newspapers.
week, were actively abusing alcohol or drugs, or were acutely sui-
cidal.
Subjects were next invited to participate in face-to-face inter-
views. At that time, the study procedures were fully explained,
and written informed consent was obtained. Two semistructured
diagnostic interviews were then administered to each subject: the
Structured Clinical Interview for DSM-IV Axis I Disorders (6) and
the Revised Diagnostic Interview for Borderlines (DIB-R) (7). Two
observer-rated scales were also administered: the Modified Overt
Aggression Scale (8) and the Montgomery-Åsberg Depression
Rating Scale (9).
Subjects were included if they met both DIB-R and DSM-IV cri-
teria for borderline personality disorder. They were excluded if
they met current or lifetime criteria for schizophrenia, schizoaf-
fective disorder, or bipolar I or bipolar II disorder or were cur-
rently in the midst of a major depressive episode.
Study duration was 8 weeks. Subjects were seen every week for
the first month and then biweekly for the next month. Both psy-
chiatric rating scales were readministered at each subsequent
visit. Side effects were also assessed at these visits with a struc-
tured questionnaire.
Subjects received two capsules per day (beginning the day after
their baseline assessment); each capsule contained either 500 mg
of 97% E-EPA or a placebo (mineral oil). One gram was chosen as
the dose most likely to be effective on the basis of unpublished
studies in depression (David Horrobin, personal communication,
Feb. 1, 2001). Capsules were supplied by Laxdale Pharmaceuticals
(Stirling, U.K.).
Between-group baseline demographic variables and clinical
history variables were analyzed by using chi-square analyses for
categorical variables and Student’s t test for continuous variables.
Source: Archives of General PsychiatrySource: Am. Journal of Psychiatry

0
0.25
0.50
0.75
1.00
Before supplementation During supplementation
RatioofDisciplinaryIncidentsSupplementation/Baseline
Active
Placebo
Reduced
Felony
Violent
Oﬀenses
Among
Prisoners

with
recommended
daily
amounts
of
vitamins,
minerals
and
essen=al
fay
acids
UK
maximum
security
prison
-‐
338
oﬀences
among
172
prisoners
over
9
months
treatment
in
a
compared
to
9

months
baseline.

Gesch
et
al.

Br
J
Psychiatry
2002,
181:22-‐28
Ac=ve
-‐37.0%

p
‹
0.005
Placebo
-‐10.1%

p
=
ns
Physiological
Kernel

Why not reproduce the rapid
results in the US to get a 37%
reduction in jail violence?
It cost the Brits 19¢ per day or $69.35 per year.

Omega-3 Status and US Military Suicide Deaths
Suicide Deaths of Active-Duty US Military and
Omega-3 Fatty-Acid Status: A Case-Control Comparison
Michael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD;
Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS
ABSTRACT
Background: The recent escalation of US military
suicide deaths to record numbers has been
a sentinel for impaired force efficacy and has
accelerated the search for reversible risk factors.
Objective: To determine whether deficiencies
of neuroactive, highly unsaturated omega-3
essential fatty acids (n-3 HUFAs), in particular
docosahexaenoic acid (DHA), are associated with
increased risk of suicide death among a large
random sample of active-duty US military.
Method: In this retrospective case-control
study, serum fatty acids were quantified as
a percentage of total fatty acids among US
military suicide deaths (n=800) and controls
(n=800) matched for age, date of collection of
sera, sex, rank, and year of incident. Participants
were active-duty US military personnel
(2002–2008). For cases, age at death ranged
from 17–59 years (mean=27.3 years, SD=7.3
years). Outcome measures included death by
suicide, postdeployment health assessment
questionnaire (Department of Defense Form
2796), and ICD-9 mental health diagnosis data.
Results: Risk of suicide death was 14% higher per
SD of lower DHA percentage (OR=1.14; 95% CI,
1.02–1.27; P.03) in adjusted logistic regressions.
Among men, risk of suicide death was 62%
greater with low serum DHA status (adjusted
OR=1.62; 95% CI, 1.12–2.34; P.01, comparing
DHA below 1.75% [n=1,389] to DHA of 1.75%
and above [n=141]). Risk of suicide death was
52% greater in those who reported having seen
wounded, dead, or killed coalition personnel
(OR=1.52; 95% CI, 1.11–2.09; P.01).
Suicide rates among active-duty US military have increased to re-
cord numbers, doubling since the inception of Operation Enduring
Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the
battlefield in toll on the US military.1 Army Vice–Chief of Staff General
Peter W. Chiarelli described the record suicide rate as “horrible” and
voiced frustration that “the Army has not yet been able to identify any
causal links among the suicide cases.”2(pA2)
Deficiencies of nutrients critical for brain function may be a signifi-
cant contributing risk factor for psychiatric pathology, especially suicide
and stress-related psychiatric symptoms.3 Highly unsaturated omega-3
essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid
(DHA), are selectively concentrated in neural tissues and are required
for optimal neural function.4
These fatty acids cannot be made de novo
but are available only from dietary sources, with seafood being the richest
source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil-
ity to combat deployment stress, manifesting as psychiatric symptoms
including adjustment disorders, major depression, impulsive violence,
and suicide.5 In civilian populations, observational studies indicate that
low fish consumption is associated with increased risk of completed sui-
cides6,7
and greater suicidal ideation.8
Low DHA status was associated
with increased risk of past suicide attempts9
and future suicide attempts.10
In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal
thinking and depressive symptoms and reduced the perception of stress
among subjects (n=49) with deliberate self-harm.11
These findings suggest that low DHA levels may be a contributing
factor for adverse psychiatric symptoms. In this study, we posited that
low DHA status would be associated with increased risk of suicide death
among military personnel. Prospectively collected serum and supporting
data were available from the Armed Forces Health Surveillance Center
(AFHSC) for a large number of active-duty suicide deaths (n=800) and
matched controls (n=800). To our knowledge, this is the largest study of

REVIEW Open Access
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids:
a novel preventive strategy for posttraumatic
stress disorder?
Yutaka Matsuoka1,2
Abstract
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless
of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric
condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially
important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity
to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence
and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and
proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting
hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of
injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately
after accidental injury can reduce subsequent PTSD symptoms.
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3
through neurogenesis by omega-3 fatty acids: a novel
preventive strategy for posttraumatic stress disorder?
Matsuoka
http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)
Omega-3 for PTSD symptoms could be used
routinely for the patients exposed to trauma
REVIEW Open Access
through neurogenesis by omega-3 fatty acids:
a novel preventive strategy for posttraumatic
stress disorder?
Yutaka Matsuoka1,2
Abstract
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless
of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric
condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially
important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity
to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence
and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and
proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting
hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of
injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately
after accidental injury can reduce subsequent PTSD symptoms.
http://www.bpsmedicine.com/content/5/1/3
through neurogenesis by omega-3 fatty acids: a novel
preventive strategy for posttraumatic stress disorder?
Matsuoka
http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)

Omega-3 can improve school
grades and success
-2
-1
0
1
2
3
4
5
6
7
Reading Spelling
Omega 3 Placebo
These were gains in
academics after 3
months of exposure
to ﬁsh oil.
Before Omega 3
After Omega 3
See www.durhamtrial.org/

Hedelin et al. BMC Psychiatry 2010, 10:38
http://www.biomedcentral.com/1471-244X/10/38
Open AccessRESEARCH ARTICLE
© 2010 Hedelin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Research article
Dietary intake of fish, omega-3, omega-6
polyunsaturated fatty acids and vitamin D and the
prevalence of psychotic-like symptoms in a cohort
of 33 000 women from the general population
Maria Hedelin*1,2, Marie Löf3, Marita Olsson3,4, Tommy Lewander1, Björn Nilsson1, Christina M Hultman1,3 and
Elisabete Weiderpass2,3,5
Abstract
Background: Low intake of fish, polyunsaturated fatty acids (PUFA) and vitamin D deficiency has been suggested to
play a role in the development of schizophrenia. Our aim was to evaluate the association between the intake of
different fish species, PUFA and vitamin D and the prevalence of psychotic-like symptoms in a population-based study
among Swedish women.
Methods: Dietary intake was estimated using a food frequency questionnaire among 33 623 women aged 30-49 years
at enrolment (1991/92). Information on psychotic-like symptoms was derived from a follow-up questionnaire in the
years 2002/03. Participants were classified into three predefined levels: low, middle and high frequency of symptoms.
The association between diet and psychotic-like symptoms was summarized in terms of relative risks (RR) and
corresponding 95% confidence intervals and was evaluated by energy-adjusted multinomial logistic regression.
Results: 18 411 women were classified as having a low level of psychotic-like symptoms, 14 395 as middle and 817 as
having a high level. The risk of high level symptoms was 53% (95% CI, 30-69%) lower among women who ate fish 3-4
times per week compared to women who never ate fish. The risk was also lower for women with a high intake of
omega-3 and omega-6 PUFA compared to women with a lower intake of these fatty acids. The effect was most
pronounced for omega-6 PUFAs. The RR comparing the highest to the lowest quartile of omega-6 PUFAs intake was
0.78 (95% CI, 0.64-0.97). The associations were J-shaped with the strongest reduced risk for an intermediate intake of
fish or PUFA. For fatty fish (herring/mackerel, salmon-type fish), the strongest inverse association was found for an
intermediate intake (RR: 0.81, 95% CI, 0.66-0.98), whereas a high intake of fatty fish was associated with an increased risk
of psychotic-like symptoms (RR: 1.90, 95% CI, 1.34-2.70). Women in the highest compared with the lowest quartile of
vitamin D consumption experienced a 37% (95% CI, 22-50%) lower risk of psychotic-like symptoms.
Conclusion: Our findings raise a possibility that adult women with a high intake of fish, omega-3 or omega-6 PUFA and
vitamin D have a lower rate of psychotic-like symptoms.
Background
Even though psychoses are relatively rare, between 5-15%
of the general population has been estimated to report
single schizophrenia-like symptoms like delusions, magi-
cal thinking, and hearing internal voices at some point in
their lifetime [1-3]. The biological mechanisms underly-
ing the etiology of schizophrenia and psychotic symp-
toms are largely unknown. Genetic constitution is
important [4], but environmental factors like an
unhealthy lifestyle with a poor diet may be involved [5,6].
Schizophrenia in adulthood is often preceded by milder
symptoms and delusions during adolescence. The typical
age of onset for schizophrenia is early adulthood (20-25
years of age). Expression of psychotic symptoms in popu-
* Correspondence: maria.hedelin@ki.se
1 Department of Neuroscience, Psychiatry, Ulleråker, Uppsala University,
Uppsala, Sweden
Full list of author information is available at the end of the article
ENVIRONMENT AND SCHIZOPHRENIA
Developmental Vitamin D Deficiency and Risk of Schizophrenia: A 10-Year Update
John J. McGrath*,1,2,3
, Thomas H. Burne1,2
, Francxois Fe´ron4
, Allan Mackay-Sim5
, and Darryl W. Eyles1,2
1
Queensland Center for Mental Health Research, The Park Center for Mental Health, Wacol, Queensland 4076, Australia; 2
Queensland
Brain Institute, University of Queensland, St Lucia, Queensland 4076 Australia; 3
Department of Psychiatry, University of Queensland, St
Lucia,Queensland4076Australia;4
NeurobiologiedesInteractionsCellulairesetNeurophysiopathologie(CNRSUMR6184),Universite´ de
la Me´diterraneé (Aix-Marseille II), Faculte´ de Me´decine Nord, Institut Fe´de´ratif de Recherche Jean Roche (IFR11), Marseille, France;
5
NationalCenterforAdultStemCellResearch,EskitisInstituteforCellandMolecularTherapies,GriffithUniversity,Brisbane,Queensland
4111, Australia
*To whom correspondence should be addressed; tel: þ61-7-3346-6372, fax: þ61-7-3271-8698, e-mail: john_mcgrath@qcmhr.uq.edu.au
There is an urgent need to generate and test candidate risk
factors that may explain gradients in the incidence of
schizophrenia. Based on clues from epidemiology, we pro-
posed that developmental vitamin D deficiency may con-
tribute to the risk of developing schizophrenia. This
hypothesis may explain diverse epidemiological findings in-
cluding season of birth, the latitude gradients in incidence
and prevalence, the increased risk in dark-skinned migrants
to certain countries, and the urban-rural gradient. Animal
experiments demonstrate that transient prenatal hypovita-
minosis D is associated with persisting changes in brain
structure and function, including convergent evidence of al-
tered dopaminergic function. A recent case-control study
based on neonatal blood samples identified a significant as-
sociation between neonatal vitamin D status and risk of
schizophrenia. This article provides a concise summary
of the epidemiological and animal experimental research
that has explored this hypothesis.
Key words: vitamin D/schizophrenia/epidemiology/
animal models/neurodevelopment/prevention
Introduction
There is robust evidence demonstrating that the risk of
schizophrenia varies according to season of birth, place
of birth, and migrant status.1
We propose that develop-
mental vitamin D (DVD) deficiency underlies these
gradients.2
Over the last decade, we have undertaken
a coordinated program of animal experiments, assay
development, and analytic epidemiology in order to ex-
plore this hypothesis. This article summarizes the current
research related to this hypothesis and makes recommen-
dations for future research. Key features of the evidence
are summarized in table 1.
Vitamin D—The Basics
Ultra Violet B (UVB) radiation on the epidermis converts
a cholesterol metabolite to vitamin D3 (cholecalciferol;
a preprohormone). This is subsequently hydroxylated
to 25-hydroxyvitamin D3 (25OHD), a prehormone com-
monly used to measure vitamin D status. A second hy-
droxylation of this molecule converts 25OHD to the
active secosteroid hormone 1,25-dihydroxyvitamin D3
(1,25OHD). This hormone binds the vitamin D receptor
(VDR), a member of the nuclear receptor superfamily.
In concert with a range of binding partners and coactiva-
tors (including the retinoid X receptor), this phylo-
genetically ancient system influences the expression
of many genes in mammals. Vitamin D is a potent
prodifferentiating and antiproliferative agent.
Vitamin D deficiency (25 nmol/l) and insufficiency
(25–50 nmo/l) are common in many nations.6–8
Hypovi-
taminosis D is more prevalent in winter, in high latitudes,
and in dark-skinned individuals. Migrants to European
countries are at higher risk of hypovitaminosis D com-
pared with native-born.9
Compared with nonimmigrants,
those from Africa have the highest adjusted ORs for vi-
tamin D deficiency (about 7-fold), followed by migrants
from Arab-Islamic countries (about 6-fold) and Turkey
(about 4-fold).10
Apart from darker skin color, variables
related to dress (eg, wearing a veil), behavior (eg, less out-
door activities), and diet also contribute to an increased
risk of deficiency in certain ethnic groups.11,12
Urban res-
idence is associated with an increased risk of hypovitami-
nosis, due to factors such as reduced outdoor activity and
access to UVB radiation.13,14
Schizophrenia Bulletin
doi:10.1093/schbul/sbq101
Ó The Author 2010. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
For permissions, please email: journals.permissions@oxfordjournals.org.
1
Schizophrenia Bulletin Advance Access published September 10, 2010
atUQLibraryonSeptember19,2010schizophreniabulletin.oxfordjournals.orgDownloadedfrom
Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant
Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections?
Dennis K. Kinney1–3
, Pamela Teixeira2
, Diane Hsu2
, Siena
C. Napoleon2,4
, David J. Crowley2
, Andrea Miller2
,
William Hyman2
, and Emerald Huang2
2
Genetics Laboratory, McLean Hospital, Belmont, MA; 3
De-
partment of Psychiatry, Harvard Medical School, Boston, MA;
4
Wellesley College, Wellesley, MA
Previous surveys found a large (10-fold) variation in
schizophrenia prevalence at different geographic sites
and a tendency for prevalence to increase with latitude.
We conducted meta-analyses of prevalence studies to inves-
tigate whether these findings pointed to underlying etiologic
factors in schizophrenia or were the result of methodolog-
ical artifacts or the confounding of sites’ latitude with level
of healthcare at those sites. We found that these patterns
were still present after controlling for an index of health-
care—infant mortality—and focusing on 49 studies that
used similar diagnostic and ascertainment methods. The
tendencies for schizophrenia prevalence to increase with
both latitude and colder climate were still large and signif-
icant and present on several continents. The increase in
prevalence with latitude was greater for groups with low
fish consumption, darker skin, and higher infant mortali-
ty—consistent with a role of prenatal vitamin D deficiency
in schizophrenia. Previous research indicates that poor pre-
natal healthcare and nutrition increase risk for schizophre-
nia within the same region. These adverse conditions are
more prevalent in developing countries concentrated near
the equator, but schizophrenia prevalence is lowest at
sites near the equator. This suggests that schizophrenia-
producing environmental factors associated with higher lat-
itude may be so powerful they overwhelm protective effects
of better healthcare in industrialized countries. The ob-
served patterns of correlations of risk factors with preva-
lence are consistent with an etiologic role for prenatal
vitamin D deficiency and exposure to certain infectious dis-
eases. Research to elucidate environmental factors that un-
derlie variations in schizophrenia prevalence deserves high
priority.
Key words: epidemiology/etiology/immune function/
prenatal/geography/risk factor
Introduction
Schizophrenia is an unusually burdensome disorder be-
cause of the great economic costs of extensive care and
loss of economic productivity, as well as the personal suf-
fering and stigma, which often affect a patient and his or
her family for most of the patient’s life. Moreover, for
most patients there is still no cure or even an effective
way of treating many of the most disabling, ‘‘negative’’
symptoms of the disorder. Therefore, a key goal of schizo-
phrenia research is elucidation of etiologic factors, partic-
ularly environmental ones that could be readily avoided
and used in effective, inexpensive, and ethically sound pri-
mary prevention programs.
In a comprehensive survey of schizophrenia prevalence
studies around the world that were published in English
over a period of 4 decades, Torrey1
noted 2 important
patterns. First, prevalence rates varied widely at different
geographic sites, with the highest rate being more than 10
times greater than the lowest. Second, there was a strong
tendency for schizophrenia prevalence to increase with
increasing latitude; ie, prevalence rates tended to be
very low near the equator and to increase as one moved
toward the poles. Both of Torrey’s conclusions were also
reached in a survey and meta-analysis by Saha et al,2
which included more recent studies as well as ones pub-
lished in languages other than English. Several other sur-
veys have also concluded that schizophrenia rates vary at
least 10-fold around the world, including studies using
measures of point prevalence, lifetime prevalence, and
incidence.1,3–10
Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009
doi:10.1093/schbul/sbp023
Advance Access publication on April 8, 2009
byguestonFebruary10,2012http://schizophreniabulletin.oxfordjournals.org/Downloadedfrom

Goal Maps (visual organized brief
motivational interview)
Relational
Frame
Kernel
Creates verbal
relations for the
behavior
Cigarettes Consumed
Alcohol Consumed
Marijuana Consumed

First children learn a vision of a wonderful school

Wait for the Timer for tobacco
addictions with SMI/CMI
Antecedent
Kernel
Happens
BEFORE the
behavior

Beat the timer in school to
improve engagement
Antecedent
Kernel
Happens
BEFORE the
behavior

Trend-line for humorous warnings on binge drinking
by women of child-rearing age
No Warnings Humorous Warnings
Antecedent
Kernel

Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
0
4
8
12
16
20
Percentage
No Warnings Humorous Warnings
Antecedent
Kernel

Acceptance Commitment
Therapy Kernels
Go to www.ContextualPsychology.org

Writeathoughtandafeelin
g
on the leaf and put it on the thoughts and feelings“stream”
Iamhavingthethoughtthat… I am having a feeling of …
Copyright © 2007-2012,PAXIS Institute. All rights reserved.
May be reproduced but not sold.www.paxtalk.com
I am having a sensation of …

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#-#)%*!
J(J6*%7'(-DL@3DL!
F5J)(#8!
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UniversalTargeted
Kernels lower cost of training, support change…
Kernels provide robustness, cost-efﬁciency and community sustainability across multi-problem behaviors.
Intervention

Media promoting recovery
Do you market the harms and dangers?
Or, do you market recovery?

Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30 40 50
Time in Months
Treatment Strategy #1 Treatment Strategy #2
Only 17% of the
discharged clients
of program #1 have
not relapsed,been
re-arrested,or
re-hospitalized by
48 months.
About 80% of the
discharged clients
of program #2
“survived”with
no relapse,
re-arrested,or
re-hospitalization by
48 months.
Do these two
evidence- based
strategies look
signiﬁcantly
different at 20
days?

Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30 40 50
Time in Months
Treatment Strategy #1 Treatment Strategy #2
Only 17% of the
discharged clients
of program #1 have
not relapsed,been
re-arrested,or
re-hospitalized by
48 months.
About 80% of the
discharged clients
of program #2
“survived”with
no relapse,
re-arrested,or
re-hospitalization by
48 months.

Percentage of patients in recovery during followup year.
Harrow M et al. Schizophr Bull 2005;31:723-734
Percentage of
patients in recovery
during followup year.
Note: SZ =
schizophrenia,
SZNIF =
schizophreniform,
OP = other
psychotic, NP =
nonpsychotic.
Non-psychotic
Other psychotic
Schizophreniform
Schizophrenia

Percent of Patients Ever in Recovery (5 Follow-ups Over 15 Years).

Percent of Nonmedicated Schizophrenia and Schizophreniform Patients in Recovery at 15-Year Follow-ups.

Recognition/Rewards
for Successs
Vaccine
Recipe Identify
Behaviors
Reduced
Identify
Behaviors
Increased
List local,
state and
national
policies
positively
impacted or
lled by
recipe
Psychinfo
www.pubmed.gov
ERIC
NTIS
User T
Local
State
National
Cite relevant
studies
Cite relevant
endorsements
or standards
Create policy
funding supports
(organizational,
local and/or state
Cultivate some
current or
prospective early
adopters for
testimonials Lo Hi
- A
catchy positive
name (meme)
-
What the
ts are
- Where/
how to get
recipe
- Relational framing
Support
Training
Daily, Weekly
or Monthly
Feedback
res
TH
cacy,
Adoption,
Implementation,
Maintenance
- What
the costs of use
are
Developmental stages
Multiple
Settings
Fam
ilies
Schools
Communities
Organiations
Birth Childhood Adolescence Adulthood
Intensity/reachlevels
High Intensity
Low reach
Low
Intensity
A
B
C
Hi
reach
Impacting Values
Evaluation
Outcome
Monitoring
Population Targeting
The path
from
research
ﬁndings
to public
health
policy
and
impact

Dennis D. Embry, Ph.D.
dde@paxis.org
520-299-6770
Business cards available
for follow up and copies
of papers presentations

Creating a culture of prevention and recovery

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